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Bloodborne Pathogens. Preventing Transmission of Bloodborne Pathogens. Are transmissible in health care settings Can produce chronic infection Are often carried by persons unaware of their infection.

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Bloodborne Pathogens


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    1. Bloodborne Pathogens

    2. Preventing Transmission of Bloodborne Pathogens • Are transmissible in health care settings • Can produce chronic infection • Are often carried by persons unaware of their infection Bloodborne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV)

    3. Potential Routes of Transmission of Bloodborne Pathogens Patient DHCP Patient DHCP Patient Patient

    4. Factors Influencing Occupational Risk of Bloodborne Virus Infection • Frequency of infection among patients • Risk of transmission after a blood exposure (i.e., type of virus) • Type and frequency of blood contact

    5. Average Risk of Bloodborne Virus Transmission after Needlestick

    6. Concentration of HBV in Body Fluids HighModerate Low/Not Detectable BloodSemen Urine SerumVaginal FluidFeces Wound exudatesSaliva Sweat Tears Breast Milk

    7. Estimated Incidence of HBV Infections Among HCP and General Population, United States, 1985-1999 HealthCarePersonnel General U.S.Population

    8. HBV Infection Among U.S. Dentists Percent Year Source: Cleveland et al., JADA 1996;127:1385-90. Personal communication ADA, Chakwan Siew, PhD, 2005.

    9. Hepatitis B Vaccine • Vaccinate all DHCP who are at risk of exposure to blood • Provide access to qualified health care professionals for administration and follow-up testing • Test for anti-HBs 1 to 2 months after 3rd dose

    10. Transmission of HBV from Infected DHCP to Patients • Nine clusters of transmission from dentists and oral surgeons to patients, 1970–1987 • Eight dentists tested for HBeAg were positive • Lack of documented transmissions since 1987 may reflect increased use of gloves and vaccine • One case of patient-to-patient transmission, 2003

    11. Occupational Risk of HCV Transmission among HCP • Inefficiently transmitted by occupational exposures • Three reports of transmission from blood splash to the eye • Report of simultaneous transmission of HIV and HCV after non-intact skin exposure

    12. HCV Infection in Dental Health Care Settings • Prevalence of HCV infection among dentists similar to that of general population (~ 1%-2%) • No reports of HCV transmission from infected DHCP to patients or from patient to patient • Risk of HCV transmission appears very low

    13. Transmission of HIV from Infected Dentists to Patients • Only one documented case of HIV transmission from an infected dentist to patients • No transmissions documented in the investigation of 63 HIV-infected HCP (including 33 dentists or dental students)

    14. Documented Possible Dental Worker 0 6 * Nurse 24 35 Lab Tech, clinical 16 17 Physician, nonsurgical 6 12 Lab Tech, nonclinical 3 – Other 8 69 Total 57 139 Health Care Workers with Documented and Possible Occupationally Acquired HIV/AIDS CDC Database as of December 2002 * 3 dentists, 1 oral surgeon, 2 dental assistants

    15. Risk Factors for HIV Transmission after Percutaneous Exposure to HIV-Infected Blood CDC Case-Control Study • Deep injury • Visible blood on device • Needle placed in artery or vein • Terminal illness in source patient Source: Cardo, et al., N England J Medicine 1997;337:1485-90.

    16. Characteristics of Percutaneous Injuries Among DHCP • Reported frequency among general dentists has declined • Caused by burs, syringe needles, other sharps • Occur outside the patient’s mouth • Involve small amounts of blood • Among oral surgeons, occur more frequently during fracture reductions and procedures involving wire

    17. Exposure Prevention Strategies • Engineering controls • Work practice controls • Administrative controls

    18. Engineering Controls • Isolate or remove the hazard • Examples: • Sharps container • Medical devices with injury protection features (e.g., self-sheathing needles)

    19. Work Practice Controls • Change the manner of performing tasks • Examples include: • Using instruments instead of fingers to retract or palpate tissue • One-handed needle recapping

    20. Administrative Controls • Policies, procedures, and enforcement measures • Placement in the hierarchy varies by the problem being addressed • Placed before engineering controls for airborne precautions (e.g., TB)

    21. Post-exposure Management Program • Clear policies and procedures • Education of dental health care personnel (DHCP) • Rapid access to • Clinical care • Post-exposure prophylaxis (PEP) • Testing of source patients/HCP

    22. Post-exposure Management • Wound management • Exposure reporting • Assessment of infection risk • Type and severity of exposure • Bloodborne status of source person • Susceptibility of exposed person